Journal of Neurology

, Volume 265, Issue 3, pp 522–529 | Cite as

Treatment of multiple sclerosis relapses with high-dose methylprednisolone reduces the evolution of contrast-enhancing lesions into persistent black holes

  • Maria Di Gregorio
  • Lorenzo Gaetani
  • Paolo Eusebi
  • Piero Floridi
  • Antonella Picchioni
  • Giovanni Rosi
  • Andrea Mancini
  • Chiara Floridi
  • Francesca Baschieri
  • Lucia Gentili
  • Paola Sarchielli
  • Paolo Calabresi
  • Massimiliano Di Filippo
Original Communication



The MRI evidence of persistent black holes (pBHs) on T1-weighted images reflects brain tissue loss in multiple sclerosis (MS). The evolution of contrast-enhancing lesions (CELs) into pBHs probably depends on the degree and persistence of focal brain inflammation. The aim of our retrospective study was to evaluate the effect of a single cycle of intravenous methylprednisolone (IVMP), as for MS relapse treatment, on the risk of CELs’ evolution into pBHs.

Patients and methods

We selected 57 patients with CELs on the baseline MRI scan. We evaluated the evolution of CELs into pBHs on a follow-up MRI scan performed after ≥ 6 months in patients exposed and not exposed to IVMP for the treatment of relapse after the baseline MRI.


In our cohort, 182 CELs were identified in the baseline MRI and 57 of them (31.3%) evolved into pBHs. In the multivariate analysis, the exposure of CELs to IVMP resulted to be a significant independent protective factor against pBHs’ formation (OR 0.28, 95% CI 0.11–0.766, p = 0.005), while ring enhancement pattern and the fact of being symptomatic were significant risk factors for CELs’ conversion into pBHs (OR 6.42, 95% CI 2.55–17.27, p < 0.001 and OR 13.19, 95% CI 1.56–288.87, p = 0.037).


The exposure of CELs to a cycle of IVMP as for relapse treatment is associated with a lower risk of CELs’ evolution into pBHs. Future studies are required to confirm the potential independent protective effect of IVMP on CELs’ evolution into pBHs.


Multiple sclerosis Black holes Methylprednisolone Steroid 


Author contributions

MDG, LGa, PC, and MDF conceived the study. MDG, LG, AM, FB, LGe, PS, PC, and MDF took clinical care of the patients. MDG, AP, GR, CF, and PF collected and interpreted the MRI data of the patients. LGa and MDG selected the patients for the study and collected their clinical data. PE performed statistical analysis. MDG, LGa, and MDF prepared the manuscript draft. PF prepared Fig. 2. All the authors participated to and revised the final version of the manuscript.

Compliance with ethical standards

Conflicts of interest

MDG received travel grants from Biogen-Idec, Biogen, Novartis, Teva, Genzyme, and Almirall to attend national and international conferences. LGa received travel grants from Biogen-Idec, Biogen, Novartis, Teva, Genzyme, and Almirall to attend national and international conferences. AM received travel grants from Teva and Sanofi Genzyme to attend national conferences. PC received/receive research support from Bayer Schering, Biogen-Dompé, Boehringer Ingelheim, Eisai, Lundbeck, Merck-Serono, Novartis, Sanofi-Aventis, Sigma-Tau, and UCB Pharma. MDF participated to advisory boards and received speaker/writing honoraria and funding for traveling from: Bayer, Biogen-Idec, Genzyme, Merck, Novartis, Roche, and Teva. PE, PF, AP, GR, CF, FB, LGe, and PS report no conflicts of interests. The study is not industry-sponsored.

Ethical standard statement

 The authors declared that they have complied with ethical standards. The study was approved by the local Ethics Committee.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maria Di Gregorio
    • 1
  • Lorenzo Gaetani
    • 1
  • Paolo Eusebi
    • 1
  • Piero Floridi
    • 2
  • Antonella Picchioni
    • 1
  • Giovanni Rosi
    • 3
  • Andrea Mancini
    • 1
  • Chiara Floridi
    • 4
  • Francesca Baschieri
    • 1
  • Lucia Gentili
    • 1
  • Paola Sarchielli
    • 1
  • Paolo Calabresi
    • 1
    • 5
  • Massimiliano Di Filippo
    • 1
  1. 1.Clinica Neurologica, Dipartimento di MedicinaUniversità degli Studi di PerugiaPerugiaItaly
  2. 2.S.C. Neuroradiologia, Azienda Ospedaliera di PerugiaPerugiaItaly
  3. 3.Sezione di Diagnostica per Immagini, Dipartimento di Scienze Chirurgiche e BiomedicheUniversità degli Studi di PerugiaPerugiaItaly
  4. 4.Dipartimento di RadiologiaOspedale Fatebenefratelli e OftalmicoMilanItaly
  5. 5.IRCCS Fondazione Santa LuciaRomeItaly

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